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As coronavirus spreads in Delaware nursing homes, families wonder if they will be able to say goodbye

We are providing this content free as a public service to readers during the coronavirus outbreak. Please support the work we're doing by subscribing to Delaware Online.

Since he was a boy, John Dean has heard his father talk about death.

He watched him do it in the pulpit at Westminster Presbyterian Church in Rehoboth Beach where his dad, the Rev. John W. Dean, often shared anecdotes comparing a baby in the womb minutes from birth to an elderly person minutes from death.

Neither knew what was on the other side, he said. But when they got there — to the world and to heaven — they realized it wasn’t so bad; they weren't alone.

Through the years, the reverend, now 86, made it clear to his two children what he wanted the end of his life to be like. No fuss and no extraordinary attempts to keep him alive. Just a quiet goodbye.

So after he suffered a stroke last month, his family knew what to do and helped him move into hospice care in Milford.

Then the coronavirus pandemic hit, and everything changed.

The only way the family can see their patriarch is by camping out on a small stone patio outside the French doors leading into their father's room. When his eyes are open, they smile and wave at him, and he smiles back, clearly aware they're there.

The Dean family is not alone in its plight.

As Delaware braces for a substantial spike in confirmed coronavirus cases, nursing homes and assisted living centers are taking unprecedented steps by banning family members from regularly visiting their loved ones, some of whom are close to death.

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John Dean, left, watches his father Rev. John W. Dean from outside his room at Delaware Hospice in Milford. Due to safety precautions because of the spread of the coronavirus, Dean is forced to sit outside and can't be next to his father unless death is imminent. "I sit out here two to four hours every day," said Dean. "Nobody should die alone."(Photo: Jerry Habraken, Delaware News Journal)

John Dean isn’t sure how much time his father has, and the family worries he will die alone after he spent most of his life consoling church members and presiding over funerals.

“We want more for him than that,” John Dean said. “He deserves more for himself than that.”

And yet, the wisdom of keeping people out of places like Delaware Hospice, nursing homes and other locations that care for the elderly is increasingly apparent in Delaware.

Eight of the state's 14 deaths related to the coronavirus have been associated with nursing homes and assisted living communities. On Saturday, the state said there were 23 cases, include the eight deaths, in five longterm care facilities.

The facilities include Little Sisters of the Poor Jeanne Jugan Residence in Ogletown, HarborChase of Wilmington, Brandywine Living at Seaside Pointe in Sussex County and Governor Bacon Health Center in Delaware City. The state on Saturday declined to identify the fifth facility.

State officials are investigating the source of exposure in each case.

This reflects a grim trend nationwide. The coronavirus makes its way into the homes of the oldest and sickest. Like influenza, COVID-19 spreads easily and attacks the body, particularly the lungs. Health officials say it is 10 times deadlier than the seasonal flu.

The pandemic, which has turned life upside down in Delaware, has many fearing that their siblings or parents could be the next one to contract the virus, especially because testing and personal protective equipment for health care workers is limited.

But Dean has a different fear.

Will he miss a chance to say goodbye?

The people's pastor

The Rev. John W. Dean was not your grandmother's minister.

In his youth, he rode a motorcycle, sometimes with his toddler son aboard. He believed women should be ordained in the church. And in the 1990s, Dean vocalized his support for the LGBTQ community.

The reverend was the people’s pastor in a way, becoming famous for being available for last-minute beach weddings and memorial services. In the 1970s, he hosted a radio show broadcasting weekly sermons throughout Delaware.

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The Rev. John W. Dean, former pastor at Westminster Presbyterian Church in Rehoboth Beach.(Photo: Jerry Habraken, Delaware News Journal)

He became so popular that hospital patients often listed him as their minister despite never having met him. The patients had heard him on the radio and wanted him to be there for their toughest moments.

He retired in 2011. In mid-March, he suffered a stroke, which led to his stay at Delaware Hospice. He has diabetes and, following the death of his wife, his health has steadily declined over the last three years.

His son said his father values quality of life and has opted for palliative care.

No one in the family was prepared for his final days to be like this, though.

As of April 4, the state has confirmed 593 cases of coronavirus. Of those cases, 153 people infected are over the age of 65, including the 14 deaths. Everyone who has died has been a senior with underlying health issues.

The Sports Medicine Gym at the Nemours Alfred I. duPont Hospital for Children was quickly changed into an alternative care site to help hospitals deal with patients who do not have the coronavirus. Damian Giletto/Delaware News Journal

Gov. John Carney shows off his homemade mask after his press briefing Thursday, a day after the state recommended Delawareans wear cloth face coverings in public settings where social distancing is difficult to maintain. Those settings include grocery stores and pharmacies. ESTEBAN PARRA/DELAWARE NEWS JOURNAL

Kena Ford walks towards the Circle K in Claymont on Wednesday, April 8. She's been wearing a mask in public from day one because she has asthma and is a breast cancer survivor. "I've only been coming out once a week," she said. Jenna Miller/Delaware News Journal

Mallory Holloway works out on the McKean High School track. The Conrad freshman has found success in cross country and track despite being born with cystic fibrosis. WILLIAM BRETZGER, DELAWARE NEWS JOURNAL

13-year-old Ellie records a tight shot of he father, chef Robert Lhulier, as he demonstrates how to cut brussel sprouts during a Facebook Live in their home kitchen. Jennifer Corbett, Delaware News Journal

13-year-old Ellie records a Facebook Live with her dad Wilmington chef Robert Lhulier as he does cooking demonstrations on using fresh vegetables in their home kitchen. Jennifer Corbett, Delaware News Journal

Gov. John Carney speaks with Dr. Karyl Rattay, director of the state Division of Public Health, before administration offices conduct a press briefing on the state's response to Covid-19 Thursday at the Carvel State Building. WILLIAM BRETZGER, DELAWARE NEWS JOURNAL

John Dean, left, watches his father Rev. John W. Dean from outside his room at Delaware Hospice in Milford. Due to safety precautions from the spread of the coronavirus Dean is forced to sit outside and can't be next to his father unless death is imminent. "I sit out here 2 to 4 hours everyday," said Dean. "Nobody should die alone." Jerry Habraken, Delaware News Journal

Kena Ford cleans her car at Circle K in Claymont on Wednesday, April 8. She's been wearing a mask in public from day one because she has asthma and is a breast cancer survivor. "I've only been coming out once a week," she said. Jenna Miller/Delaware News Journal

Fred McDade pumps gas at the Circle K in Claymont on Wednesday, April 8. He was an early adaptor to wearing a mask in public. "People were looking at me like I was crazy a month ago... not so much now," he said. Jenna Miller/Delaware News Journal

Usually busy with rush hour traffic heading between Wilmington and Philadelphia, movement on the I-95 near Delaware's border is light as residents shelter-in-place during the coronavirus pandemic on Wednesday, April 8. Jenna Miller/Delaware News Journal

16-year-old twins Ryan and Marco (right) Caba-Acevedo complete work on the computer out of their Newark apartment on Tuesday, April 7. Marco said he thought remote learning would be more difficult, but the classes are currently just reviewing past concepts. Jenna Miller/ Delaware News Journal

Delaware State Police began on Friday preventing some out-of-state visitors from entering local businesses near the Northtowne Plaza Shopping Center. JOHN J. JANKOWSKI JR./SPECIAL TO DELAWARE NEWS JOURNAL

Golfers play at the Deerfield Golf Club in Newark on Monday, April 6. The course has made changes to address the coronavirus pandemic but remains open. Jenna Miller/Delaware News Journal, Delaware News Journal

IndutexUSA President George Gianforcaro speaks to the media about the arrival of nearly 500,000 disposable face masks Tuesday morning at D&S Wharehousing Inc in Newark. The masks are assumed to be heading to COVID-19 hotspots across the United States and possible local hospitals in Delaware. Jerry Habraken, Delaware News Journal

President and co-owner of Mispillion River Brewing Eric Williams stands for a portrait inside their bar room in Milford. The business is hoping state and federal loans can help keep them afloat until the coronavirus pandemic is over. Jerry Habraken, Delaware News Journal

Marilyn Dickey, of Newark, uses a pattern to cut material before sewing face mask for the facebook group called Help for Healthcare Workers Delaware, started by her daughter Kristen Barnekov-Short. The group is making face masks for nursing homes and any other nurses in need of face mask that have become hard to obtain during the coronavirus outbreak. Jennifer Corbett, Delaware News Journal

A sign outside George & Sons' Seafood Market and Oyster House announces that the store remains open for takeout food and beer, but the lot sits mostly empty amid the coronavirus pandemic on Thursday, April 2. Jenna Miller/Delaware News Journal

The beach areas of Rehoboth and Dewey, usually gearing up for the summer season, are quiet due to restrictions meant to halt the spread of COVID-19 amid a global pandemic. Chuck Snyder/Special to the Delaware News Journal

The beach areas of Rehoboth and Dewey, usually gearing up for the summer season, are quiet due to restrictions meant to halt the spread of COVID-19 amid a global pandemic. Chuck Snyder/Special to the Delaware News Journal

The beach areas of Rehoboth and Dewey, usually gearing up for the summer season, are quiet due to restrictions meant to halt the spread of COVID-19 amid a global pandemic. Chuck Snyder/Special to the Delaware News Journal

The beach areas of Rehoboth and Dewey, usually gearing up for the summer season, are quiet due to restrictions meant to halt the spread of COVID-19 amid a global pandemic. Chuck Snyder/Special to the Delaware News Journal

Plenty of cars still drive along Kirkwood Highway on Thursday, April 2, over a week after Gov. Carney issued a stay-at-home order for all non-essential workers in Delaware amid the coronavirus pandemic. Jenna Miller/Delaware News Journal

Marilyn Dickey, of Newark, sits at her breakfast table and sews face mask for the facebook group called Help for Healthcare Workers Delaware, started by her daughter Kristen Barnekov-Short. The group is making face masks for nursing homes and any other nurses in need of face mask that have become hard to obtain during the coronavirus outbreak. Jennifer Corbett, Delaware News Journal

A sign broadcasts the closure of Brandywine High due to the coronavirus pandemic on Wednesday, April 1. All Delaware schools have been shut down through at least May 15 and are working to adapt to distance learning. Jenna Miller/Delaware News Journal

Since Delaware confirmed its first case, Gov. John Carney has expressed anxiety about older Delawareans, often talking about how he worries about his own mother.

The governor said Monday he has "quite a bit of concern" that nursing homes and assisted living facilities haven't been doing enough to prepare for the coronavirus and protect patients and workers. He said the state is stepping up its guidance for these facilities.

Of the 46 Delaware nursing homes rated on Medicare's Nursing Home Compare website, many have had issues related to infection. In the past three years, 80% of these nursing homes have had one or more violations, according to an analysis by Delaware Online/The News Journal.

The issues related to either not providing and implementing an infection prevention and control program or not having a sufficient program that investigates, controls and keeps infection from spreading.

Sixty percent of these nursing homes had more than one violation, according to the analysis.

The Little Sisters of the Poor Jeanne Jugan Residence in Ogletown was the only one of the three facilities that had a death last week — including HarborChase and Brandywine Living — to be rated on Medicare's website.

The nursing home has a 5-star rating, which is higher than the national average and has not had any complaints that resulted in a citation by Medicare in three years.

Yet, at Little Sisters of the Poor, seven residents had tested positive for the coronavirus and six have died as of Sunday, April 4.

All these residents were in the facility’s nursing care unit because they were in fragile health, said Sister Constance Veit, the facility’s spokeswoman.

The two nursing units have been quarantined. The sick and the well residents have been separated and are cared for by separate staff, Veit said.

She said “no one superfluous” is allowed in these areas, and family members are only allowed in if a resident is dying. If this does occur, only one visitor is allowed in at a time and they are gowned and masked.

In the residential area, the seniors are asked to remain in their rooms and are provided tray service for meals, she said.

“There is absolutely no congregating or socializing in the lounges and other common areas,” Veit said.

HarborChase of Wilmington, where six residents have tested positive as of last week, has taken similar steps, said David Dodson, vice president of sales and marketing for Harbor Retirement Associates.

As of Wednesday, no other residents or staff members have tested positive for coronavirus, Dodson said. And many of those who have tested positive are “doing well and improving.”

Weeks ago, the nursing home banned visitors as well as communal dining and events, he said.

At Delaware Hospice, where John Dean’s father is staying, the decision to stop visitation was not an easy one, said CEO Susan Lloyd.

“This is unprecedented,” she said.

Lloyd said the organization has a responsibility to keep its residents and staff safe.

“We feel terrible,” she said. “It’s a very difficult situation for families who are at the end of life.”

For patients who have "significant changes" for the worse, Lloyd said, the hospice center will contact family and allow some visitors. But it is unclear when that happens.

Dean said he finds the policy “barbaric.” He understands the concerns about the coronavirus and said he is willing to be screened for symptoms and wear protective gear.

Late last week, Dean tried to move his father, who has stabilized, back into the nursing home he previously lived in. The visitation policy, he said, would allow his father to have one visitor at a time.

But the nursing home declined. Dean was told the facility had a limited number of beds due to the coronavirus.

His father would have to remain in hospice, alone.

Staying until the end

The Deans have come prepared for this cold and damp Wednesday. They have a portable awning and camping chairs, the kind you sit in for kids’ soccer games. Blankets cover their legs.

There are barely any cars in Delaware Hospice’s parking lot. But John and Elizabeth, the reverend's daughter, and her husband Michael are there. They will stay for hours, reminiscing about how the reverend would make them look at family photos on his slide projector.

The nurses have turned John Dean’s bed so he can see his children. Some of his grandchildren have already said their goodbyes.

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John Dean, left, his sister Elizabeth Thompson, center, and her husband Michael Thompson sit outside the room of Dean's father, Rev. John W. Dean, at Delaware Hospice in Milford. Due to the spread of the coronavirus, family members are forced to visit from outside patients' rooms. John Dean sits outside his father's room two to four hours a day.(Photo: Jerry Habraken, Delaware News Journal)

Some days, John speaks to his father on the phone. But the man's voice is weak, and it’s become harder to understand him. The conversations last only minutes. The son has tried to watch his father lips, to piece together what he’s trying to say.

The reverend doesn’t understand why his children can't come inside and instead are sitting outside in the cold. John has explained the pandemic, the increase in cases and the new rules.

But his father cannot conceive the magnitude of what's happened since March 11, when the first case of COVID-19 was confirmed in Delaware.

Across the state, Nancy Levenson can now see her sister, who lives at Brandywine Living at Seaside Pointe near Rehoboth Beach, only by waving outside her window in the memory care unit. Levenson asked for her sister's name not to be published out of concern for her privacy.

The nursing home banned visitors March 12, the day before Levenson’s sister’s birthday.

This meant Levenson couldn’t visit her sister and treat her to cake and ice cream like she always does.

Levenson said she received an email from the facility, alerting her about a resident testing positive. She said she learned of the resident’s death by reading Delaware Online.

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Scenes from inside the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the call center at the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Governor John Carney tours the State Health Operation Center Monday in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the call center at the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the Joint Information Center at the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the State Health Operations Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the call center at the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the call center at the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Governor John Carney tours the State Health Operation Center Monday in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the call center at the State Health Operations Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Governor John Carney tours the State Health Operation Center Monday in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Governor John Carney speaks to the media after touring the State Health Operations Center Monday in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Governor John Carney tours the State Health Operation Center Monday in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Governor John Carney tours the State Health Operation Center Monday in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Governor John Carney watches President Donald Trump address the country on new guidelines to help prevent spreading of the coronavirus at the State Health Operations Center in Smyrna. Jerry Habraken, Delaware News Journal

Scenes from inside the call center at the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the call center at the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Governor John Carney tours the State Health Operation Center Monday in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the call center at the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the call center at the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Governor John Carney tours the State Health Operation Center Monday in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the call center at the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

An unused break room at the Health Operations Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the call center at the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the call center at the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the call center at the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Governor John Carney tours the State Health Operation Center Monday in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the Joint Information Center at the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Governor John Carney tours the State Health Operation Center Monday in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the Joint Information Center at the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

Scenes from inside the Joint Information Center at the State Health Operation Center in Smyrna. The center is the state's primary location for planning and operations to prevent the spreading of the coronavirus in Delaware. Jerry Habraken, Delaware News Journal

The nursing home said last week that no other residents have been confirmed with the virus, and no staff members are self-isolating. The facility is conducting an investigation into how the resident was exposed to the virus.

While Levenson thinks her sister receives good care at the facility, she worries about the lack of supplies and protective equipment they have available.

The state’s current policy is to only test those who show symptoms until “we identify the risk to other residents and staff to implement further infection control measures,” said state spokeswoman Stacey Hofmann.

“Not all individuals with symptoms need to be tested once the risk assessment is completed,” she said.

According to the Centers for Disease Control and Prevention, a Washington state long-term care facility found that 50% of positive cases were in people who had no symptoms.

“Evidence of asymptomatic spread reinforces for us the incredibly important message, that we all have to act as though we have the virus," Hoffman said.

“I want to protect (her),” Levenson said of her older sister. “I love her. She shouldn’t be a sitting duck in a place like this. They should be shielding them as much as they can.”

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Rev. John W. Dean lies in his bed at Delaware Hospice in Milford. Unable to have his family in the room because of the threat of COVID-19, he watches and waves from his bed.(Photo: Jerry Habraken, Delaware News Journal)

Back in Milford, almost every afternoon, no matter the weather, John Dean sits outside his father’s window. As a shop teacher for Mariner Middle School, Dean is currently working from home.

Elizabeth lives in Maryland, but joins her brother when she can. She longs to hold her dad's hand and stroke his head. No one knows if she will have a chance to do that again.

Dean won’t leave until it gets dark, when the reverend can no longer see him.

He believes his dad would notice if he wasn't there.

The other day, Dean said, a nurse asked his father if he knew who was sitting outside his window.

That's my son, the reverend replied.

Data reporter Jared Whalen contributed reporting to this article.

Contact Meredith Newman at (302) 324-2386 or at mnewman@delawareonline.com. Follow her on Twitter at @merenewman.

Meredith Newman, health reporter

As Delaware Online's health reporter, I believe there has never been a more important time for local journalism. In the midst of this pandemic, I work tirelessly to make sure Delawareans are given the most accurate information. There is no job I'd rather do. Your subscriptions are direct investments in reporters like me. It allows me to continue to dig deeper and keep asking hard questions to those in power. Your support makes a difference.